Module 3 & 4 NDNQI Pressure Injury (Questions and answers) LATEST UPDATE

Reposition Seated Patients - ️️Patients should be seated in a way that minimizes pressure and prevents sliding and shear Limit the time the patient spends seated in a chair Patients who can reposition themselves should be taught to weight shift every 15 minutes for approximately 2 minutes Push-up weight shifts, forward-lean weight shifts, and side-lean weight shifts can be used Patients who cannot reposition themselves should be repositioned at least every hour by a caregiver Use a pressure redistributing chair cushion that is appropriate to the patient's needs. Ensure that feet are properly supported on the floor, foot stool or foot rest. Neonate Protection - ️️For neonates, soft bedding, high specification foam, or gel mattress have been recommended for pressure redistribution Children should be placed on a support surface that fits their body proportion and size. Support surfaces such as a low-air-loss bed or alternating overlay should be age appropriate and safe. Because the occiput is the largest bony prominence in younger children, use a high specification foam overlay or gel pad/pillow under the head to reduce occipital pressure. Be sure to reposition the head periodically like any other high risk bony prominence. Place a high specification foam cushion or gel under the head of children undergoing surgery Head Team Leader - ️️Be the hospital expert in skin and pressure injury risk assessment Be able to accurately stage pressure injuries using the NPUAP pressure injury staging system Be able to differentiate pressure injuries from other wound types and skin injuries For NDNQI, the Head Team Leader must be familiar with NDNQI® Guidelines for Data Collection and Submission on Pressure Injuries located on the member website Adult Patient Pressure Injury Risk Assessment tools - ️️The Braden Scale, and the Norton Scale, have been validated for adult use in research studies. These are the two scales most commonly used in the United States Pediatric/Neonate Pressure Injury Risk Assessment tools - ️️The Braden Q was tested in PICU patients age 21 days to 8 years The Glamogram Scale was tested in pediatric patients age 1 day to 18 years The Neonatal Skin Risk Assessment Scale (NSRAS) was tested in Neonatal Intensive Care Unit patients age 26-40 weeks gestationPressure Injury Risk Assessment Scores - ️️Braden Scale scores range from 6 to 23 Norton Scale scores range from 5 to 20 Braden Q scores range from 7 to 28 NSRAS scores range from 6 to 24 For the Braden Scale, a score of 18 or less indicates that the patient is at risk for pressure injuries For the Norton Scale, a score of 15-16 or less indicates the patient is at risk for pressure injuries For the Braden Q, a score of 16 or less indicates the patient is at risk for pressure injuries For the NSRAS, a score of 13 or higher indicates the neonate is at risk for skin injury Risk for Pressure Injury - ️️Skin Status Existing pressure injuries History of pressure injuries General skin status Decreased perfusion and oxygenation Peripheral vascular disease Hypotension Use of vasopressors Nutrition Related Examples Recent weight loss Protein energy malnutrition Age Related Examples Older age Gestational prematurity Surgery Related Examples Operation greater than 4 hours The number of hypotensive episodes intra-operatively Low body temperature intra-operatively Additional Examples Exposure to pressure from a medical device such as oxygen tubing, CPAP mask, cervical collar, etc. Spinal cord injury Increased body temperature Program of Pressure Injury Prevention - ️️Daily Skin Assessment Pressure Redistribution Surface Use Routine Repositioning Nutritional SupportMoisture Management Support Surfaces - ️️Support surfaces are used to redistribute pressure on skin and subcutaneous tissue or alternate parts of the body exposed to pressure. Support surfaces are made up of various components including air, gel, water and various types of foam. High specification foam is preferred. These materials are used to make mattresses, overlays, specialty mattresses or chair cushions that redistribute pressure over tissues. Support surfaces may have additional features such as alternating pressure, air fluidization, low air loss, multi-zones, turn assist or lateral rotation.1 Heel Protection - ️️Suspend/"float" heels off the surface of the bed by placing a pillow under the lower legs so that the heels are free of pressure Avoid areas of high pressure, especially under the Achilles tendon. Heel protection devices should completely elevate the heels off the mattress Consider use of a multi-layer silicone bordered foam dressing on the heels to minimize shear injury in high risk patients